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INFECTION AND IMMUNOLOGY > J Letchford Lec 6 Tuberculosis > Flashcards

J Letchford Lec 6 Tuberculosis Flashcards

1
Q

Tuberculosis is often caused by M_______ T______.

A

Mycobacterium tuberculosis

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2
Q

Tuberculosis is a major opportunistic infection in ____ patients.

It is often called a la__ infection

A

AIDS

Latent

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3
Q

Tuberculosis is often caused by M_____ T______.

This is a slow growing b______.

It is an a____ fast bacteria.
It’s cell wall is rich in lipids
It is very hydro____ and resistant to drying

What will happen in a gram stain?
Why?

A

Mycobacterium Tuberculosis

Bacillus

Acid fast bacteria

Will not show up in gram stain as it’s fatty acids are resistant to gram stain and antibiotics.

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4
Q

M.tuberculosis complex:

M.tuberculosis, M.b____

M.africanum, M.m____

A

M.tuberculosis, M.bovis

M.africanum, M.microti

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5
Q

Primary tuberculosis:

Stage 1:
- B____ inhaled in droplets (need close contact for prolonged period of time)

  • _______ by macrophages
  • Macrophages do not destroy the b_____
A

Bacilli

Phagocytosed

Bacilli

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6
Q

Primary tuberculosis

Stage 2:
- M.TB multiplies inside _______ for 7-21 days

  • ______ burst
  • Incoming macrophages _______ released M.TB
A

Macrophages

Macrophages

Phagocytose

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7
Q

Primary tuberculosis

Stage 3:

  • Cell mediated response initiated
  • Tu____ formed that contain the bacilli in a collagen layer
A

Tubercules

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8
Q

Tuberculosis infections can be…

1) C______
2) Remain as a l_____ _____
3) Progress

A 
Cleared
Latent infection (most bacillus killed off in tubercles but some can remain dormant)
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9
Q

Primary tuberculosis

Stage 4:
- Bacteria multiply inside _____ if not controlled by the immune system and t______ rupture (uncontrolled lysis)

  • Enzymes are released which destroy local tissues and cause l____
  • This can be pulmonary TB (in lungs)
  • Extra pulmonary TB (if into blood stream e.g immunocomp)
A

Macrophages

Tubercules

Lesions

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10
Q

What are 5 symptoms of TB?

A

1) Cough (prolonged and productive)
2) Afternoon fever
3) Weight loss
4) Blood stained sputum
5) Night sweats

(inability to thrive in children)

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11
Q

Diagnosis of Active TB:
Clinical exam

Chest x-ray (white l_____ replace alveoli with ____ _____)

Sputum test; smears and/or cultures:
Visualise TB bateria in sputum by staining and microscopy
Culture bacteria (see if strain is _____)

A

Lesions

Scar tissue (poor gas exchange)

Resistant

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12
Q

Diagnosis of latent TB:
_______ skin test:

______ injected s.c into forearm
POSITIVE: skin lesion bigger than 10mm diameter after 48 - 72hr

Molecular assays:

  • Expert MTB/RIF assay (PCR amplifie bacterial genes to detect presence of bacillus)
  • In___ ____ tests
A

Tuberculin skin test

Tuberculin injected S.C into forearm

Interferon gamma tests

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13
Q

Screening for TB on entry to UK:

  • Compulsory for those travelling from country where TB common if want to stay in UK for more than _ months.
  • Need BEFORE apply for ____
  • Chest x-ray
  • _____ test
A

6 months

VISA

Sputum-test

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14
Q

Prevention of TB - immunisation

\_\_\_ vaccine (up to 2005)
Given to \_\_\_ \_\_\_\_ groups
A

BCG

High risk

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15
Q

Main criteria for anti-TB drugs:

  • _______ activity (as bac divide in _____)
  • Combination therapies (to reduce _____)
  • Prolonged therapy with min SE’s and low toxicity

_ first line anti-TB drugs used as combination

A

Intracellular activity (as bacteria divides in macrophages)

To reduce resistance

4 first line anti-TB used in combination

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16
Q

1st line anti-TB drug: R______ (inhibit ___ polymerase)

  • Bacteri____
  • Orally absorbed
  • Abs decreased by food

SE’s:

  • ____ damage
  • Hypersensitivity
  • ____ activity of other drugs
  • ____ ____ in body fluids
A

Rifampicin

Bactericidal

Liver damage

Reduce activity

Red colour (breast milk, tears)

17
Q

1st line anti-TB drug: I_______

  • Bacter_____ or bacteri_____ pro-drug
  • Decrease synth _____ acid (lipid component cell wall)

PK: IV, IM, ORAL
Distributed in CSF
Metab in ____, excreted by ____

SE's:
Hypersensitivity 
Peripheral neuropathy 
Liver toxicity (LFT)
Reduced efficacy of \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_
A

Isoniazid

Bactericidal or bacteriostatic pro drug

Decrease synthesis of mycolic acid (lipid component of cell wall)

Liver

Kidneys

Hormonal birth control

18
Q

1st line anti-TB drug: P_______

  • Bacteri____, antibiotic prodrug
  • Decrease synthesis of m____ acid/ damages bacterial membrane

PK: oral, well abs
Metab by ____, excrete by ____

SE’s:

  • Joint pain
  • _____ damage
  • Hypersensitivity
A

Pyrazinamide

Bactericidal

Mycolic acid (in lipid cell wall)

Liver, Kindeys

Liver damage

19
Q

1st line anti-TB drug: E______

  • Bacteri____
  • Increase _____ __ ___ ___

PK:
Oral, well absorbed, well distributed
50% excreted unchanged

SE’s:
_____ neuritis: reversible (colour blindness and impaired)
Joint pain

A

Ethambutol

Bacteriostatic

Increase permeability of cell wall

Optic neuritis

20
Q

Which 1st line drugs do the following?

1) Inhibit cell wall synthesis
2) Inhibit cell wall synthesis
3) Inhibit RNA synthesis
4) Disrupts plasma membrane and disrupts energy metabolism

Rifampicin, Ethambutol, Pyrazinamide, Isoniazid

A

Isoniazid

Ethambutol

Rifampicin

Pyrazinamide

21
Q

2nd line anti-TB drugs:

Aminoglycosides: S_____, Capreomycin

C______: (neurological SE’s)

Quinolone: Ci_____

Macrolide: Az_____

A

Streptomycin

Cycloserine

Ciprofloxacin

Azithromycin

22
Q

Treatment of TB:

Active TB: RIPE

  • R______ and I______ for _ to _ months
  • P______ for _ months and E______
Latent TB: 
Treat specific patient groups
- I\_\_\_\_\_ 6 months 
OR
- R\_\_\_\_\_ and I\_\_\_\_\_\_ 3 months
A

Rifampicin and Isoniazid for 6-9 months
Pyrazinamide for 2 months and Ethambutol

Isoniazid 6 months

Rifampicin and Isoniazid 3 months

23
Q

TB and resistance:

  • Results from poorly managed TB care

MDR-TB - Strains resistant to _ or more of first line drugs

XDR-TB - Strains resistant to _ or more of first line drugs AND _ or more of second line drugs

A

2 or more

2 or more

3 or more

INFECTION AND IMMUNOLOGY (14 decks)

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